Conclusion: The Chief Public Health Officer's Report on the State of Public Health in Canada 2013 – Continuing efforts
This report was not intended to cover all aspects of all infectious diseases in Canada. The topics chosen touched on issues that warrant further attention and illustrate key aspects of infection prevention and control. Themes emerged and common threads wove their way through the sections. Antimicrobial resistance recurred as an issue in the discussions on healthcare-associated infections and tuberculosis. Immunization was included in the piece on sexually transmitted infections. Overlaps occurred between the food-borne and water-borne infections and the antimicrobial resistance sections with the shared roles of industry and the healthcare sector in making progress on these issues. And the concept of shared responsibility–among industry, governments, healthcare and individuals–was woven throughout.
A century ago, it was not uncommon to die from an infectious disease. Today, as a result of advances in the prevention and control of infectious diseases, Canadians can expect to live long, vibrant and healthy lives in one of the healthiest nations in the world. Prevention is, as always, the first line of defence. Canada has made great strides in implementing public health initiatives to maintain and improve the health of Canadians. Success stories range from changes in healthcare (e.g. mass immunization programs) and infrastructure (e.g. water treatment systems) as well as education campaigns around safer sex, correct handwashing, protecting others when we cough and sneeze, and methods for safe food preparation. We also have better surveillance systems in place, giving us a clearer picture of immunization rates and the distribution of diseases.
But the fact remains that many of us are affected by infectious diseases. Recent decades have seen the rise of new diseases as well as the continuation of old problems that still threaten our health. To foster real progress in health and well-being, we need to manage disease at the individual and population level and mitigate its impact over the long term. Additionally we are discovering more and more diseases that were once thought non-infectious (chronic) to have an infectious cause or risk factor. Thus our growing understanding of infection and immunity will be critical to future prevention and treatment efforts.
These efforts, again, are a shared responsibility, and activities range from research into and the development of new drugs and treatments to appropriate antibiotic use and better surveillance and monitoring. We also need to maintain protection practices to prevent further infection and improve access for screening and timely diagnosis, especially in vulnerable populations.
Any long-term infectious disease strategy needs to address the social determinants of health. Both the onset and progression of disease are affected by the economic and social supports available to Canadians. Marginalized populations are affected differently by infectious diseases, and our knowledge of how they are affected is only just emerging through surveillance and monitoring activities.
Infectious diseases are not new. We have been facing such challenges throughout history–from the Plague of Athens in 430 BCE, to the Black Death in the 14th century, to the cholera pandemics in the 19th century, to the "Spanish flu" in 1918, to the H1N1 flu pandemic in 2009. We must remain vigilant. We must continue our efforts to prevent illness from the many known, harmful communicable agents in our midst and also plan for the unknown and unexpected threats that may also emerge. We can do this through active monitoring of diseases here and around the world and through improving our ability to flexibly respond to these diseases. By working together and sharing knowledge we can play a part in protecting global health. To stay ahead of emerging and re-emerging threats, infection prevention and control must evolve as the nature of infection evolves. It is clear that we will continue to be challenged by infectious diseases in the future, but further gains are possible if we focus on the actions suggested in this report.
As the World Health Organization notes, good health is not necessarily about living a longer life, but living one free of disability and disease. At the end of the day, it comes down to us. Our society is only as healthy as the least healthy among us. Looking at the health of Canadians from a public health perspective makes it clear that everything is connected. Preventing or managing human disease without considering the context in which it occurs will not help us act. By better understanding the issues and connections that make some people sick while others stay well may, at the very least, help us avoid being part of the problem.
Centuries of dealing with infectious diseases have taught us that fighting them must take as broad a scope as possible. Every community is going to have a different experience with disease, reinforcing the need for every Canadian to be able to act. During the H1N1 flu pandemic, for example, as people coughed into their sleeves, stayed home if they were sick, washed hands and used sanitizers, we reduced the spread of illness. Our individual actions can and do make a difference every day.
It is true that the threat of infection in a developed country does not seem as critical as it does in a less developed one. However, Canadians are still getting sick from infectious disease. Some of the sickness is becoming long-term and treatment-resistant, and creates situations of vulnerability. Over the past 40 years, we have seen over 35 new diseases emerge, others that mutated in response to human actions and many that resulted from our interactions with animals and the environment. These threats make it clear that we cannot let our guard down.
We can work to reduce infectious diseases and be better prepared for unexpected events. Many infectious diseases are treatable and manageable, especially if we all work together. We must do our part to ensure a healthy population. All of us, from individuals, to employers to decision makers, have a part to play in improving public health. Our watchword going forward might be PACEM, which is Latin for "peace" and an acronym for Partnership, Advocacy, Cheerleading, Enabling and Mitigating. Partnership means taking the shared view to respond to infectious disease. Advocacy means bringing forward practical solutions for individuals and industry, government and healthcare sectors so that they can begin to make a difference. Cheerleading involves stepping aside to help others focus on their successes in infectious disease prevention and control. Enabling is providing the evidence that different sectors need in order to take correct action. And Mitigating means minimizing risks to health, so that we don't have to pick up the pieces later. As we each take ownership of this issue, to the best of our capabilities, we can help to ensure that all Canadians have the opportunity to be as healthy as possible.
Dr. David Butler-Jones
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